[Gastric cancer. Treatment in 2008]

In gastric cancer treatment, the recent advances concern mainly the lymphadenectomy and adjuvant or neoadjuvant treatment of surgical resection. Progressively in western countries, the D1 lymphadenectomy is performed in large population with an improvement of survival rate of patients. Recently, in two randomized studies, a significantly decrease of recurrence with hazard ratio near of 0.70 has been demonstrate with perioperative chemotherapy. However, the post-operative chemoradiotherapy shown too, in prospective randomized study, a significantly benefit on recurrence risk with hazard ratio of 0.50. In fact, feasibility of postoperative chemoradiotherapy was weak, near to 65%. The preoperative chemoradiotherapy is a promising alternative. A phase II study of preoperative chemoradiotherapy is ongoing by french intergroup. The design with two parallel groups evaluate the feasibility of chemotherapy (FOLFIRI) and then chemoradiotherapy (45 Gy, 5FUIVc) in postoperative or preoperative period.